USAID Administrator discusses “transformational goals” to include curing 2.4 million infected with TB

USAID Administrator Rajiv Shah (right) waits to give the David E. Barmes Global Health Lecture at the National Institutes of Health Tuesday.

In a prestigious lecture to the National Institutes of Health (NIH) scientific community Tuesday, U.S. Agency on International Development (USAID) Administrator Rajiv Shah spoke about efficiencies that can be gained under the Global Health Initiative (GHI) and a renewed focus on “facilitating a continuum of invention and innovation from bench to bush,” at the agency.

Shah’s speech highlighted five areas where health gains can be realized: vaccines and immunizations; malaria; mother and child health and family planning; HIV prevention; and tuberculosis. “If we can target the freed resources provided by GHI toward the expansion of these new scientific breakthroughs, I believe by 2016, we can save the lives of more than 3 million children, prevent more than 12 million HIV infections, avert 700,000 malaria deaths, ensure nearly 200,000 pregnant women can safely give birth, prevent 54 million unintended pregnancies and cure 2.4 million people infected with TB,” Shah said.

The administrator stated that while the agenda is daunting, the work is worthwhile and desperately needed. “A child born today in Swaziland will live half as long as one born 11 years ago, due to a rampant HIV epidemic,” Shah said, while also noting that more than 350,000 women will die this year in pregnancy or childbirth, 8 million children will die of a preventable disease before their fifth birthday, and 2.6 million people will be newly infected with HIV. “As Secretary Clinton has noted, this undermines social stability and threatens our own long-term security,” Shah said.

Realizing what can be done with the scientific and technical breakthroughs at the agencies’ disposal will depend on a strong partnership between USAID and NIH, according to Shah. Together, the two agencies will focus on the implementation of research innovations and scaling them up so their full potential can be realized, improving the efficiency of agency efforts and focusing on building country-led health systems instead of donor-driven disease control programs.

“We stand on the cusp of the next generation of science, technology, pricing, and operational breakthroughs. If we can find the courage to do things differently, and quickly deliver these breakthroughs to the field, we can usher in a new decade unprecedented global health gains,” Shah said.

One such breakthrough, the Gene Xpert machine, was recently supported by the World Health Organization for its rapid diagnostic capabilities for tuberculosis, multi-drug resistant TB (MDR-TB) and TB in HIV-infected individuals. The machine produces test results in about 100 minutes, whereas current testing methods can take up to three months. Shah lauded the innovation during his speech, but warned it could be cost prohibitive in the developing world, stating that each machine costs $25,000. Fortunately, the machine’s co-developer, the Foundation for Innovative New Diagnostics (FIND), announced in a press release in December that it has negotiated the price of the machine down to $17,000 for 120 high-burden, low- and middle-income countries. Shah also said that individual testing cartridges cost between $20 and $60 a piece, which is true for developed countries, but FIND also negotiated the cartridge price for these 120 countries down to less than $17, and the price is set to drop to $10.72 by 2014 as demand increases. Cepheid, the manufacturer of the Gene Xpert, also recently announced that the machine may evolve to measure HIV viral load in addition to TB its diagnostic capacity.

While the administrator gave no specifics, during the question and answer session he did say that the Gene Xpert would be available at field sites with help from the Global Fund. And while it won’t happen right away, it will happen, he said.

During a conference call with reporters later in the afternoon, Science Speaks asked about the role of USAID in TB vaccine development. Amie Batson, Deputy Assistant Administrator for Global Health at USAID, responded saying that USAID does consider the development of a TB vaccine a priority, “and we look strongly to partners at NIH to be leading and driving some of that discovery, but we see USAID paving the way and then very rapidly introducing it and scaling it up as soon as we can.”

Batson did not make clear what investment USAID would make in the late-stage trials for TB vaccines, although USAID is currently charged with the responsibility to fund late-stage trials in this area.

Absent from Shah’s talk was an explicit suggestion of the importance of continuing to expand access to antiretroviral treatment. Advocates and scientists warn that stalling the expansion of treatment would undermine efforts to improve maternal and child survival rates, to address TB-HIV co-infection, and to reduce transmission between individuals, ultimately benefiting the community at large.